Late effects in survivors treated for lymphoma as adolescents and young adults: a population-based analysis



The study objective is to describe and quantify the incidence of treatment-induced late effects in AYA lymphoma patients.


Consecutive patients diagnosed with Hodgkin lymphoma (HL) or non-Hodgkin lymphoma (NHL) at 15–24 years of age were identified. All patients in British Columbia who received radiation therapy (RT) from 1974 to 2014 with ≥ 5-year survival post-RT were included. Late effects’ analyses included only survivors who received RT to the relevant anatomical site(s) and/or relevant chemotherapy, and were reported as cumulative incidence (CI) ± standard error.


Three hundred and five patients were identified (74% HL). Median age of diagnosis was 21 years. Median follow-up was 19.1 years for secondary malignancy and 7.2 years for other endpoints. Hypothyroidism was the most prevalent late effect, with a CI of 22.4 ± 2.8% and 35.1 ± 4% at 5 and 10 years, respectively. CI of in-field secondary malignancy was 0.4 ± 0.4% at 10 years and 2.8 ± 1.2% at 20 years. CI of symptomatic pulmonary toxicity was 4.6 ± 1.5% and 6.8 ± 2.0% at 5 and 10 years, respectively, and was higher in patients receiving multiple RT courses (p = 0.009). Esophageal complications occurred at a CI of 1.4 ± 0.8% at 5 years and 2.2 ± 1.1% at 10 years. CI of xerostomia/dental decay was 2.6 ± 1.3% at 5 years and 4.9 ± 2.1% at 10 years. CI of cardiac disease was at 2.3 ± 0.9% at 5 years and 4.4 ± 1.5% at 10 years. CI of infertility was 6.5 ± 1.6% at 5 years and 9.4 ± 2.1% at 10 years.


Survivors of AYA lymphoma have a high incidence and diverse presentation of late effects.

Implications for Cancer Survivors

AYA lymphoma survivors should be educated about their risks of late effects and offered screening and follow-up when appropriate.

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Author information




Conceptualization: Karen Goddard, Andrea C. Lo; Methodology: Andrea C. Lo, Ben Chen, Vanessa Samuel, Kerry J. Savage, Ciara Freeman, Karen Goddard; formal analysis and investigation: Ben Chen; writing—original draft: Andrea C. Lo, Ben Chen; writing—review and editing: Andrea Lo, Ben Chen, Vanessa Samuel, Karen Goddard, Kerry J. Savage, Ciara Freeman; supervision: Andrea C. Lo, Karen Goddard.

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Correspondence to Andrea C. Lo.

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Conflict of interest

K.J.S received institutional research funding from Roche. C.F. has honoraria from Seattle Genetics, Janssen, Amgen, Celgene and Abbvie, and research funding from Roche and Teva. None of the other authors have conflicts of interest to disclose.

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This study was approved by the University of BC / BC Cancer Research Ethics Board.

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Lo, A.C., Chen, B., Samuel, V. et al. Late effects in survivors treated for lymphoma as adolescents and young adults: a population-based analysis. J Cancer Surviv (2021).

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  • Lymphoma
  • Radiation therapy
  • Radiotherapy
  • Late effects
  • Toxicities
  • Adolescent and young adult